Provider Demographics
NPI:1063689610
Name:FLORIDA KEYS NURSE REGISTRY
Entity Type:Organization
Organization Name:FLORIDA KEYS NURSE REGISTRY
Other - Org Name:GRIWOLD SPECIAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:305-296-9997
Mailing Address - Street 1:3434 RIVIERA DR
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4611
Mailing Address - Country:US
Mailing Address - Phone:305-296-9997
Mailing Address - Fax:305-295-0395
Practice Address - Street 1:3434 RIVIERA DR
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4611
Practice Address - Country:US
Practice Address - Phone:305-296-9997
Practice Address - Fax:305-295-0395
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRISWOLD SPECIAL CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3016096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL810559696OtherMEDICARE WAIVER